Does the time of isolation need to be re-evaluated in prisoners with tuberculosis?

ABSTRACT: Background: According to WHO, CDC, IDSA and ATS guidelines, patients with pulmonary tuberculosis (Tb) can be considered as non infectious when: 1) they are receiving multiple drugs for 2 to 3 weeks; 2) there is an improvement in clinical condition; 3) the likelihood of MDR-Tb is very small...

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Autores:
Vélez Giraldo, Lázaro Agustín
López López, Lucelly
Rueda Vallejo, Zulma Vanessa
Giraldo, Margarita Rosa
Marín Pineda, Diana Marcela
Zapata, Elsa
Mejía Mesa, Gloria Isabel
Robledo, Jaime
Arbeláez Montoya, María Patricia
Tipo de recurso:
Article of journal
Fecha de publicación:
2012
Institución:
Universidad de Antioquia
Repositorio:
Repositorio UdeA
Idioma:
eng
OAI Identifier:
oai:bibliotecadigital.udea.edu.co:10495/32010
Acceso en línea:
https://hdl.handle.net/10495/32010
Palabra clave:
Tuberculosis Pulmonar
Tuberculosis, Pulmonary
Aislamiento de Pacientes
Patient Isolation
Prisioneros
Prisoners
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
Description
Summary:ABSTRACT: Background: According to WHO, CDC, IDSA and ATS guidelines, patients with pulmonary tuberculosis (Tb) can be considered as non infectious when: 1) they are receiving multiple drugs for 2 to 3 weeks; 2) there is an improvement in clinical condition; 3) the likelihood of MDR-Tb is very small. Objective: To determine the time for sputum reversion since the start of anti-Tb treatment in prisoners from four jails in Medellin and Bucaramanga, Colombia between May 2010 to April 2011. Methods: Prospective cohort study. All prisoners diagnosed with Tb by sputum smear or culture were followed for two years: monthly for the first six months after the start of treatment, bimonthly the next six months, and quarterly the second year. During follow-up, we took two spontaneous and one induced sputum samples for auramine-rodhamine stain, and cultures in thin layer agar, Löwestein-Jensen and MGIT for the both first samples. We did time to event analysis. Results: We could follow 45 of 47 positive patients (one was transferred to another jail and one Tb-related death). The median for sputum smear reversion was 33 days (IQR: 31-60), and for culture was 55 days (IQR: 32-68). 90% of the patients had sputum smear and culture negative at 102 days. The time for sputum to become negative by culture had a positive correlation with the sputum grade at the moment of diagnosis: negative smear with positive culture= median 31.5 days, smear with 1+ = 58.5 days, smear 2+ = 62 days, and smear 3+ = 65 days (p value = 0.007). Conclusion: After starting treatment the reversion of cultures took two or more months in ≥50% cases. That is forcing us to rethink the recommendations about the isolation of patients with pulmonary Tb in prisons, and suggests the need to use mycobacterial cultures on sputum to follow-up those patients.